Alien plant species distribution in Romania: a nationwide survey following the implementation of the EU Regulation on Invasive Alien Species.

Background: Biological invasions pose an increasing risk to nature, social security and the economy, being ranked amongst the top five threats to biodiversity. Managing alien and invasive species is a priority for the European Union, as outlined in the EU Biodiversity Strategy for 2030 and the Kunming-Montreal Global Biodiversity Framework. Alien plant species are acknowledged to impact the economy and biodiversity; thus, analysing the distribution of such species provides valuable inputs for the management and decision-making processes. The database presented in the current study is the first consolidated checklist of alien plant species that are present in Romania, both of European Union concern and of national interest. This database complements a prior published distribution, based only on records from literature, bringing new information regarding the occurrence of alien plants in Romania, as revealed by a nationwide field survey. We consider this database a valuable instrument for managing biological invasions at both national and regional levels, as it can be utilised in further research studies and in drafting management and action plans, assisting stakeholders in making informed decisions and implementing management actions. New information: We present the results of the first nationwide survey of alien plant species in Romania, conducted between 2019 and 2022, in the framework of a national project coordinated by the Ministry of Environment, Waters and Forests and the University of Bucharest. The present database complements and updates the database published by Sirbu et. al (2022), which included occurrence records published until 2019. The new database includes 98323 occurrence records for 396 alien plant species in 77 families, with most species belonging to the Asteraceae family. One alien plant species in our database, the black locust Robiniapseudoacacia L., had more than 10,000 occurrence records. The distribution database also includes information on newly-reported invasive alien plant species of European Union concern in Romania (i.e. the floating primrose-willow Ludwigiapeploides (Kunth) P.H.Raven) and documents the presence of plants in 44 additional families compared to Sirbu et al. (2022). Each entry includes information on species taxonomy, location, year, person who recorded and identified the alien plant, geographical coordinates and taxon rank.

Chronic Kidney Disease-An Underestimated Risk Factor for Antimicrobial Resistance in Patients with Urinary Tract Infections.

(1) Background: Chronic kidney disease (CKD), as well as antimicrobial resistance (AMR) represent major global health problems, with important social and economic implications. It was reported that CKD is a risk factor for antimicrobial resistance, but evidence is scarce. In addition, CKD is recognized to be a risk factor for complicated urinary tract infections (UTIs). (2) Methods: We conducted an observational study on 564 adult in-hospital patients diagnosed with urinary tract infections. The aim of the study was to identify the risk factors for AMR, as well as multiple drug resistance (MDR) and the implicated resistance patterns. (3) Results: The mean age was 68.63 ± 17.2 years. The most frequently isolated uropathogens were Escherichia coli strains (68.3%) followed by Klebsiella species (spp. (11.2%). In 307 cases (54.4%)), the UTIs were determined by antibiotic-resistant bacteria (ARBs) and 169 cases (30%) were UTIs with MDR strains. Increased age (≥65) OR 2.156 (95% CI: 1.404−3.311), upper urinary tract obstruction OR 1.666 (1.083−2.564), indwelling urinary catheters OR 6.066 (3.919−9.390), chronic kidney disease OR 2.696 (1.832−3.969), chronic hemodialysis OR 4.955 (1.828−13.435) and active malignancies OR 1.962 (1.087−3.540) were independent risk factors for MDR UTIs. In a multivariate logistic regression model, only indwelling urinary catheters (OR 5.388, 95% CI: 3.294−8.814, p < 0.001), CKD (OR 1.779, 95% CI: 1.153−2.745, p = 0.009) and chronic hemodialysis (OR 4.068, 95% 1.413−11.715, p = 0.009) were risk factors for UTIs caused by MDR uropathogens. (4) Conclusions: CKD is an important risk factor for overall antimicrobial resistance, but also for multiple-drug resistance.

The impact of thoracic paravertebral block over post-operatory evolution in open lobectomy.

AIM: The thoracic paravertebral block (PVB), a technique of post-thoracotomy analgesia of similar effectiveness as continuous epidural analgesia (CEA) but with a better safety profile, is underutilized in current practice. This study compares the outcome of post-lobectomy patients in relation to the analgesic method used: parenteral analgesia (PA) vs. PVB + PA, and provides justification for the routine use of PVB in all patients where CEA is contraindicated. METHODS: We randomized 213 consecutive patients undergoing open lobectomy to benefit from two different protocols of postoperative analgesia: PA vs. PVB +PA. We compared the frequency of cardiac hemodynamic, respiratory, pleural or surgical-related complications. RESULTS: After lobectomy, the PVB patients (72/213) were found to have a significantly lower frequency of congestive heart failure (7.1%vs.0.0%)(p=0.049), ischemic cardiomyopathy (10.6%vs.0.0%)(p=0.010), pulmonary atelectasis (35%vs.1.1%)(p<0.001), residual pleural space (29.8%vs.15.3%)(p=0.032) and residual intrapleural blood clots (14.9%vs.1.4%)(p=0.005). Other postoperative complications, Intensive Care stay, total hospital stay and mortality rate were less frequent in the PVB group but without reaching statistical significance. CONCLUSION: The use of SPVB is associated with significant less postoperative complications than PA only. This study suggests that the SPVB might be the ideal choice in post-thoracotomy pain management when CEA cannot be used. KEY WORDS: Open lobectomy, Post-lobectomy, Thoracic paravertebral block.

[Transtumoral drilling--an efficient solution and in many cases the only one available in the surgical treatment of Klatskin tumors]. / Forajul transtumoral--solutie eficienta si de multe ori singura posibila în tratamentul chirurgical al tumorilor Klatskin.

PURPOSE: Reviewing the cases and evaluate the efficacity of the trans-tumoral drilling in the Klatskin tumours which were operated in Colentina Surgical Department. MATERIAL AND METHOD: This is a clinical retrospective study on 109 cases of Klatskin tumours operated between 1998-2004. in 80 cases of them we could practice a biliary drainage using a trans-tumoral drilling. SURGICAL INDICATION: Malignant tumours of the main biliary duct developed at the level and above the junction of the two hepatic ducts , extended to the liver in many cases. SURGICAL TECHNIQUE: Through the choledochostomy, we performed with a special instrument the trans-tumoral drilling with the setting of a biliary axial drainage (40 cases), external biliary drainage through a semirigid trans-choledochal tube (25 cases), Kehr tube (9 cases), U tube (3 cases), internal drainage with intra-choledochal stent (2 cases), lost tube (1 case). RESULTS: In all cases we observed the early decrease of the jaundice. In the cases in which we used internal drainage, we had to perform a replacement of the closed tubes in 1-2 months after the first operation. Instead, the external biliary drainage, less expensive and periodically washed to preserve his permeability, proved his high efficiency. The average survival time was 8,9 months (between 5-20 months). CONCLUSIONS: The external biliary drainage through trans-tumoral drilling remains in many cases the only one available therapeutical solution for the Klatskin tumours.

[Cancer of the head of pancreas--resection vs. palliative surgery]. / Cancerul de cap de pancreas--rezectie vs. paleatie.

Pancreatic cancer remains a disease with high mortality. The unspecific symptoms for a long time make the diagnostic difficult. Between 1995-2004, only 85 from 465 patients with this diagnosis, had pancreatic resection. To them, we performed Whipple pancreaticoduodenectomy (60), pylorus preserving pancreaticoduodenectomy (15), pancreatico-duodenectomy with preserving of duodenum (2), pancreaticoduodenectomy with associated resections (5), subtotal pancreatico-duodenectomy (30). The reconstruction after pancreatic resection was pancreatico-jejuno anastomosis (26) and pancreatico-gastro-anastomosis (59). Morbidity was about 34% and the mortality was about 9%.

[Therapeutic options in gallstone ileus]. / Optiuni terapeutice în ileusul biliar.

Gallstone ileus is a rare, serious condition, requiring emergency surgery, specific to elderly age. The present study deals with 16 cases operated in 25 years period, with median age about 64 years old. The patients had clinical evidence of intestinal obstruction, confirmed by radiological examination and ultrasonography. Emergency operations were performed. In 7 cases had been treated radically both the obstruction (entero-lithotomy) and the bilio-digestive fistula (cholecystectomy, duodenal closure, enteral closure, colon-suture) with good results (only one death). In 9 cases, it had been treated only the intestinal obstruction, with only 2 cases of persistent cholangitis. Generally, we have used biliary drainage with Kehr tube in the presence of biliary stones and cholangitis. The biliodigestive fistula may close in evolution or become a harmless secondary route for internal biliary drainage.

[One case of multiple abdominal hydatidosis]. / Un caz de chist hidatic abdominal cu localizari multiple.

It is presented the case of a 45 years old female patient transferred in our clinic from Parasitology Clinic with the diagnosis of hepato-splenic hydatidosis. Preoperative echography presented 3 abdominal hydatid cysts (hepatic, splenic and free in the peritoneal cavity--greater omentum). Intraoperative exam confirmed the preoperative evaluation. The operation consisted in two ideal cystectomies associated with one partial cystectomy with evacuation and drainage. Postoperative evolution was simple.